Though we have provided a few helpful hints for vaccinating your Medicare patients below, this article does not serve as a guarantee of payment. Furthermore, it is vital that your patient contacts their insurance plan directly if they have any questions about their coverage prior to vaccination.
Medicare Part B only routinely covers flu, Pneumovax 23, and Prevnar 13 in an outpatient setting. The patient typically does not require a copay, and rarely will a patient receive a bill, unless they receive a duplicate vaccine in the given time period, or they must coordinate their benefits.
Medicare B generally covers one flu shot per season. Pneumovax 23 and Prevnar 13 are generally covered as well, but they must be given a full calendar year apart according to Medicare requirements.
It is also important to note that per Medicare Part C (sometimes referred to as Medicare Advantage plans), patients may have a plan administered by a private payer, which has the same qualifiers as a Medicare B plan.
All Medicare or Medicare Advantage patients will show up on the Scheduler with the below eligibility response, reminding you they are Eligible, but only for flu, Pneumovax 23, and Prevnar 13.
What about Medicare Part D?
If the patient is 65 years of age or older, you will see an additional eligibility check for Med D that is available when clicking into the patient on the schedule. If the patient wishes to receive any of the vaccines coverfed under Medicare D pop-up box, you must run this additional check before proceeding to vaccinate. We cannot accept cash for Medicare D copays.
If the patient has Part B and only wishes to receive flu, Pneumovax, or Prevnar, you do not need to complete the Medicare D pop-up box or enter a credit or debit card.
If the patient only has Medicare Part B and does not have Medicare Part D, they need to self-pay for TDAP or Zoster, as they do not have insurance coverage that will cover the cost of these vaccines.
For more information on checking eligibility for Medicare D patients, check out our Med D article HERE.
For further questions, please contact Customer Care via our primary VaxCare number below.
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